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Colitis
Other Names
Ulcerative Colitis, Colitis Ulcerosa, UC, Colon Disease, Colon Diseases.

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Description
Also known as: Irritable Bowel Syndrome, IBS, Mucous Colitis, Spastic Colon.

Irritable bowel syndrome (IBS) is a very common gastrointestinal disorder that sometimes causes significant discomfort even though it is not a serious health threat. The cause of IBS remains unknown. IBS is not related to inflammatory bowel diseases, such as Crohn's disease or ulcerative colitis.

What are the symptoms of IBS? Typical symptoms include abdominal bloating and soreness, gas, and alternating diarrhea and constipation. People with IBS are more likely than others to have backaches, fatigue, and several other seemingly unrelated problems.

Conventional treatment options: The conventional treatment for IBS includes limiting intake of dairy products, beans, and foods containing caffeine, fructose, or sorbitol. Fructose is found in concentrated amounts in dried fruit and fruit juice. Sorbitol is found primarily in dietetic foods, where it is used instead of table sugar (sucrose). Fiber supplements or laxatives may be prescribed for constipation. When diarrhea or abdominal soreness are present, drugs that control colon muscle spasms and slow the movement of food through the digestive system may be used. Antidepressant and anti-anxiety drugs may also be used for people with depression or chronic pain, or for people whose symptoms worsen during periods of stress. No conventional treatments of IBS have been proven to be effective in controlled trials.

Dietary changes that may be helpful: Several trials report that food sensitivities occur in only a small percentage of people with IBS.1 2 3 However, a leading researcher in the field claims at least 3.5 ounces of the offending food need to be consumed at frequent intervals to provoke IBS symptoms,4 and the amount of test foods used in these studies was generally less than this amount. Therefore, inadequate quantities of food may have affected the outcomes of these trials. Other trials have reported that most IBS sufferers have food sensitivities, and that gas production and IBS symptoms diminish when the offending foods are discovered and avoided.5 6 7 8 Some researchers report that problem foods need to be eaten at every meal for at least two days to evaluate the potential of food sensitivity.9

Researchers have found that standard blood tests used to evaluate allergies may not uncover food sensitivities associated with IBS, because IBS food sensitivities may not be true allergies.10 11 The only practical way to evaluate which foods might trigger IBS symptoms is to avoid the foods and then reintroduce them. Such a procedure requires the guidance of a healthcare practitioner. Attempts to find and avoid problem foods without professional help may fail and may aggravate symptoms.

Preliminary evidence suggests that some people with IBS have greater trouble absorbing the sugars lactose (as found in milk), fructose (as found in high concentration in fruit juice and dried fruit), and sorbitol (as found in some dietetic candy) than do healthy people.12 In this report, restricting intake of these sugars led to reduction in symptoms in 40% of people with IBS.

Limited research has suggested that fiber might help people with IBS.13 14 However, most studies find that IBS sufferers do not benefit by adding wheat bran to their diets,15 16 17 18 and some people feel worse as a result of wheat bran supplementation.19 The lack of positive response to wheat bran may result from a wheat sensitivity,20 which is one of the most common triggers for food sensitivity in people with IBS.21 Rye, brown rice, oatmeal, barley, vegetables, and psyllium husk are good sources of fiber and are less likely to trigger food sensitivities than is wheat bran. Except for psyllium, little is known about the effects of these other fibers in people with IBS.

Nutritional supplements that may be helpful: Double-blind research has shown that avoidance of lactose (present in milk and some other dairy products) by people with IBS who are also lactose intolerant will relieve IBS symptoms.22 Alternatively, lactase enzyme may be used prior to consuming milk. Several different lactase products are commercially available and the amount needed depends on the specific preparation being used.

In one trial, women with IBS who experienced worsening symptoms before and during their menstrual period were helped by taking enough evening primrose oil (EPO) to provide 360-400 mg of gamma linolenic acid (GLA) per day.23 In that trial more than half reported improvement with EPO, but none was helped in the placebo group. The effects of EPO in other groups of IBS sufferers have not been explored.

A preliminary trial investigated the effectiveness of grapefruit seed extract in people with eczema and symptoms of IBS.24 Participants received either 2 drops of a 0.5% oral solution of grapefruit seed extract twice daily or 150 mg of encapsulated grapefruit seed extract three times daily. After a month, IBS symptoms had improved in 20% of those taking the liquid, while all of the patients taking capsules noted definite improvement of constipation, flatulence, abdominal discomfort, and night rest. These results need confirmation in double-blind trials.

Are there any side effects or interactions? Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful: Some people with IBS may benefit from bulk-forming laxatives. Psyllium seeds (3.25 grams taken three times per day) have helped regulate normal bowel activity in some people with IBS.25 Psyllium has improved IBS symptoms in double-blind trials.26 27

In the intestinal tract, peppermint oil reduces gas production, eases intestinal cramping, and soothes irritation.28 Peppermint oil has been reported to help relieve symptoms of IBS in two analyses of controlled trials.29 30 Evidence supporting the use of peppermint oil has come from double-blind trials that typically have used enteric-coated capsules that supply 0.2-0.4 ml of peppermint oil taken three times per day.31 32 33 Some trials have found peppermint oil ineffective.34 35 The reason for these conflicting findings remains unclear.

The combination of 90 mg of peppermint oil plus 50 mg of caraway oil in enteric-coated capsules taken three times per day led to significant reduction in IBS symptoms in a double-blind trial.36 In a similar trial, capsules that were not enteric-coated were as effective as enteric-coated capsules.37 The same combination has compared favorably to the drug cisapride (Propulsid) in reducing symptoms of IBS.38 The purpose of enteric coating is to protect peppermint oil while it is passing through the acid environment of the stomach.

Whole peppermint leaf is often used either alone or in combination with other herbs to treat abdominal discomfort and mild cramping that accompany IBS. The combination of peppermint, caraway seeds, fennel seeds, and wormwood was reported to be an effective treatment for upper abdominal complaints in a double-blind trial.39

Chamomile's essential oils have eased intestinal cramping and irritation in animals.40 Chamomile is sometimes used by herbalists to relieve alternating bouts of diarrhea and constipation, though research has yet to investigate these effects. This herb is typically taken three times per day, between meals, in a tea form by dissolving 2-3 grams of powdered chamomile or by adding 3-5 ml of herbal extract tincture to hot water.

A standardized Chinese herbal combination containing extracts from 20 plants (including wormwood (Artemisia absinthium),ginger, bupleurum, schisandra, and dan shen (Salvia miltiorrhiza) reduced IBS symptoms.41 In that double-blind trial, people were given five capsules of the herbal combination three times per day.

Are there any side effects or interactions? Refer to the individual herb for information about any side effects or interactions.

Other integrative approaches that may be helpful: IBS sufferers have increased sensitivity to rectal pain that has been linked to psychological factors.42 Stress is known to increase symptoms of IBS.43 Reducing stress or practicing stress management skills have been reported to be beneficial. In one trial, psychotherapy and relaxation combined with conventional treatment were more effective than conventional treatment alone in two-thirds of people with IBS.44 Hypnosis for relaxation has dramatically and consistently relieved symptoms of IBS in some people.45 46 47

Traditional Chinese Medicine (TCM), which uses acupuncture and Chinese herbal therapies, has been reported to be helpful in the treatment of IBS,48 although no formal research has evaluated this claim.

References:

1. Bentley SJ, Pearson DJ, Rix KJ. Food hypersensitivity in irritable bowel syndrome. Lancet 1983;ii:295-7.

2. McKee AM, Prior A, Whorwell PJ. Exclusion diets in irritable bowel syndrome: are they worthwhile? J Clin Gastroenterol 1987;9:526-8.

3. Farah DA, Calder I, Benson L, Mackenzie JF. Specific food intolerance: its place as a cause of gastrointestinal symptoms. Gut 1985;26:164-8.

4. Alun Jones V, Shorthouse M, Workman E, Hunter JO. Food intolerance and the irritable bowel. Lancet 1983; ii:633-4 [letter].

5. King TS, Elia M, Hunter JO. Abnormal colonic fermentation in irritable bowel syndrome. Lancet 1998;352:1187-9.

6. Alun Jones V, McLaughlan P, Shorthouse M, et al. Food intolerance: A major factor in the pathogenesis of irritable bowel syndrome. Lancet 1982;ii:1115-7.

7. Smith MA, Youngs GR, Finn R. Food intolerance, atopy, and irritable bowel syndrome. Lancet 1985;ii:1064 [letter].

8. Parker TJ, Naylor SJ, Riordan AM, Hunter JO. Management of patients with food intolerance in irritable bowel syndrome: the development and use of an exclusion diet. J Hum Nutr Diet 1995;8:159-66.

9. Birtwistle S. Letter. Lancet 1983; II:634.

10. Paganelli R, Fagiolo U, Cancian M, et al. Intestinal permeability in irritable bowel syndrome. Effect of diet and sodium cromoglycate administration. Ann Allergy 1990;64:377-80.

11. Alun Jones V, McLaughlan P, Shorthouse M, et al. Food intolerance: A major factor in the pathogenesis of irritable bowel syndrome. Lancet 1982;ii:1115-7.

12. Fernandez-Banares F, Esteve-Pardo M, de Leon R, et al. Sugar malabsorption in functional bowel disease: clinical implications. Am J Gastroenterol 1993;88:2044-50.

13. Manning AP, Heaton KW, Harvey RF, Uglow P. Wheat fibre and irritable bowel syndrome. Lancet 1977;ii:417-8.

14. Hotz J, Plein K. Effectiveness of plantago seed husks in comparison with wheat bran no stool frequency and manifestations of irritable colon syndrome with constipation. Med Klin 1994;89:645-51.

15. Cann PA, Read NW, Holdsworth CD. What is the benefit of coarse wheat bran in patients with irritable bowel syndrome? Gut 1984;25:168-73.

16. Arffmann S, Andersen JR, Hegnhoj J, et al. The effect of coarse wheat bran in the irritable bowel syndrome. A double-blind cross-over study. Scand J Gastroenterol 1985;20:295-8.

17. Soloft J, Krag B, Gudmand-Hoyer E, et al. A double-blind trial of the effect of wheat bran on symptoms of irritable bowel syndrome. Lancet 1976;i:270-3.

18. Lucey MR, Clark ML, Lowndes J, Dawson AM. Is bran efficacious in irritable bowel syndrome? A double blind placebo controlled crossover study. Gut 1987;28:221-5.

19. Francis CY, Whorwell PJ. Bran and irritable bowel syndrome: time for reappraisal. Lancet 1994;344:39-40.

20. Gaby AR. Commentary. Nutrition and Healing 1996;Feb:1,10-1 [review].

21. Niec AM, Frankum B, Talley NJ. Are adverse food reactions linked to irritable bowel syndrome? Am J Gastroenterol 1998;93:2184-90 [review].

22. Bohmer CJ, Tuynman HA. The clinical relevance of lactose malabsorption in irritable bowel syndrome. Eur J Gastroenterol Hepatol 1996;8:1013-6.

23. Cotterell CJ, Lee AJ, Hunter JO. Double-blind cross-over trial of evening primrose oil in women with menstrually-related irritable bowel syndrome. In Omega-6 Essential Fatty Acids: Pathophysiology and roles in clinical medicine, Alan R Liss, New York, 1990, 421-6.

24. Ionescu G, Kiehl R, Wichmann-Kunz F, et al. Oral citrus seed extract in atopic eczema: In vitro and in vivo studies on intestinal microflora. J Orthomol Med 1990;5:155-8.

25. Hotz J, Plein K. Effectiveness of plantago seed husks in comparison with wheat bran no stool frequency and manifestations of irritable colon syndrome with constipation. Med Klin 1994;89:645-51.

26. Jalihal A, Kurian G. Ispaghula therapy in irritable bowel syndrome: improvement in overall well-being is related to reduction in bowel dissatisfaction. J Gastroenterol Hepatol 1990;5:507-13.

27. Prior A, Whorwell PJ. Double blind study of ispaghula irritable bowel syndrome. Gut 1987;11:1510-3.

28. Leicester RJ, Hunt RH. Peppermint oil to reduce colonic spasm during endoscopy. Lancet 1982;ii:989 [letter].

29. Pittler MH, Ernst E. Peppermint oil for irritable bowel syndrome: a critical review and metaanalysis. Am J Gastroenterol 1998;93:1131-5.

30. Poynard T, Naveau S, Mory B, Chaput JC. Meta-analysis of smooth muscle relaxants in the treatment of irritable bowel syndrome. Aliment Pharmacol Ther 1994;8:499-510.

31. Rees WD, Evans BK, Rhodes J. Treating irritable bowel syndrome with peppermint oil. Br Med J 1979;2(6194):835-6.

32. Liu J-H, Chen G-H, Yeh H-Z, et al. Enteric-coated peppermint-oil capsules in the treatment of irritable bowel syndrome: a prospective, randomized trial. J Gastroenterol 1997;32:765-8.

33. Dew MJ, Evans BK, Rhodes J. Peppermint oil for the irritable bowel syndrome: A multi-center trial. Br J Clin Pract 1984;38:394-8.

34. Nash P, Gould SR, Barnardo DE. Peppermint oil does not relieve the pain of irritable bowel syndrome. Br J Clin Pract 1986;40:292-3.

35. Rogers J, Tay HH, Misiewicz JJ. Peppermint oil. Lancet 1988;ii:98-9 [letter].

36. May B Kuntz HD, Kieser M, Kohler S. Efficacy of a fixed peppermint/caraway oil combination in non-ulcer dyspepsia. Arzneimittelforschung 1996;46:1149-53.

37. Friese J, K”hler S. Peppermint/caraway oil-fixed combination in non-ulcer dyspepsia: equivalent efficacy of the drug combination in an enteric coated or enteric soluble formula. Pharmazie 1999;54:210-5.

38. Madisch A, Heydenreich CJ, Wieland V, et al. Treatment of functional dyspepsia with a fixed peppermint oil and caraway oil combination preparation as compared to cisapride. Arneimittlforschung 1999;49:925-32.

39. Westphal J, H”rning M, Leonhardt K. Phytotherapy in functional abdominal complaints: Results of a clinical study with a preparation of several plants. Phytomedicine 1996;2:285-91.

40. Achterrath-Tuckerman U, Kunde R, et al. Pharmacological investigations with compounds of chamomile. V. Investigations on the spasmolytic effect of compounds of chamomile and Kamillosanr on isolated guinea pig ileum. Planta Med 1980;39:38-50.

41. Bensoussan A, Talley NJ, Hing M, et al. Treatment of irritable bowel syndrome with Chinese herbal medicine. A randomized controlled trial. JAMA 1998;280:1585-9.

42. Whitehead WE, Palsson OS. Is rectal pain sensitivity a biological marker for irritable bowel syndrome: psychological influences on pain perception. Gastroenterology 1998;115:1263-71.

43. Dancey CP, Taghavi M, Fox RJ. The relationship between daily stress and symptoms of irritable bowel: a time-series approach. J Psychosom Res 1998;44:537-45.

44. Guthrie E, Creed F, Dawson D, Tomenson BG. AA controlled trial of psychological treatment for the irritable bowel syndrome. Gastroenterology 1991;100:450-7.

45. Harvey RF. Individual and group hypnotherapy in treatment of refractory irritable bowel syndrome. Lancet 1989;i:424-6.

46. Waxman D. The irritable bowel: a pathological or a psychological syndrome? J R Soc Med 1988;81:718-20.

47. Houghton LA, Heyman DJ, Whorwell PJ. Symptomatology, quality of life and economic features of irritable bowel syndrome-the effect of hypnotherapy. Aliment Pharmacol Ther 1996;10:91-5.

48. Pagon A. Treatment by traditional oriental medicine. Irritable bowel syndrome. J Chin Med 1998;58:28-31.

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Colitis - Symptoms, Indications and Actions

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